Pharmacy Patient Assistance Program

Drug companies have programs that give free or discount medicines to people who qualify for financial help. These programs are called patient assistance programs.  

These programs help you, St. Jude, and other families.  

• They help you by reducing worry about medicine costs and insurance.  
• They help St. Jude by allowing us to make the most of our funds.  
• They help other families because if you qualify for free or discount medicines, St. Jude does not need to help with that cost. This allows us to care for more children.

Who can get patient assistance? 

Usually, people whose insurance does not pay for prescription medicines or does not cover the entire cost. You might qualify if you meet all 3 of the following: 

• You do not have prescription drug insurance that covers your child’s medicines 
• You are a U.S. resident or citizen 
• Your annual income is at or below a certain amount, usually 200% of the U.S. federal poverty guidelines 

How to apply for patient assistance  

If your family does not have prescription drug insurance and you want to help St. Jude, please call the Pharmacy patient assistance specialist at 901-595-6390. This person will meet with you and apply for patient assistance for you.  

The patient assistance specialist will:  

• Complete applications 
• Let you know if you qualify 
• Answer your questions 

Each drug company has its own patient assistance requirements. If you qualify, your child will receive free or discounted medicines. 

Details we need from you 

We need some information from you to apply for patient assistance. The patient assistance specialist will scan or photocopy these documents: 

• Proof of income 
• IRS Form 4506, Request for Copy of Tax Return 
• IRS Form W-2, Wage and Tax Statement 
• Personal information such as date of birth, Social Security number, and household size 
• Patient or parent signatures 
• A doctor’s signature (The patient assistance specialist will get this for you.)